Thromboembolic complication rate after radical retropubic prostatectomy. Impact of routine ultrasonography for the detection of pelvic lymphoceles and hematomas.
OBJECTIVE
The impact of routine ultrasonography for diagnosis and rapid treatment of pelvic lymphoceles and hematomas on the rate of thromboembolic complications was studied.


METHODS
From June 1987 to December 1995, 508 patients underwent radical retropubic prostatectomy with low-dose heparin prophylaxis at our medical institution. Beginning with patient 321, routine pelvic ultrasonography was started on each patient on postoperative day 1 for diagnosis of lymphoceles and hematomas. The rate of thromboembolic complications in patients 321-508 was compared with that in patients 1-320 (without routine ultrasonography).


RESULTS
In patients 1-320, a total of 20 (6.2%) symptomatic thromboembolic complications occurred: five (1.6%) pulmonary emboli and 15 (4.7%) cases of deep venous thrombosis. In patients 321-508, the total rate of thromboembolic complications was significantly reduced (p = 0.049): only 4 patients (2.1%) had thromboembolic events (1 pulmonary embolism and 3 cases of deep venous thrombosis): all but 1 of the complications were associated with small hematomas, which were first negative on routine pelvic ultrasonography but positive on CT scan only done when clinical suspicion of symptoms occurred or during open surgery and showed compression of the iliac vein.


CONCLUSIONS
Pelvic lymphoceles and hematomas seem to be important cofactors in the pathophysiology of thromboembolic complications after radical retropubic prostatectomy. Most lymphoceles and hematomas can be diagnosed with pelvic ultrasonography although small hematomas can be overseen with pelvic ultrasonography Surgeons should become more aware of these postoperative complications particularly in patients on heparin prophylaxis.
Heinzer
H
H
Department of Urology, University of Hamburg, University Clinic Eppendorf, Germany.
Hammerer
P
P
Graefen
M
M
Huland
H
H
D000328:Adult; D000368:Aged; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006406:Hematoma / Q000000981:diagnostic imaging; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D008137:Longitudinal Studies; D008210:Lymphocele / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011468:Prostatectomy; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D014463:Ultrasonography
D005343:Fibrinolytic Agents; D006493:Heparin